The New loveLife Trust has launched its annual Gauge of HIV Prevention for 2009. The Gauge is unique in that it brings together all published information about the current state of the HIV epidemic in South Africa, based on both national and local studies – and identifies the top ten strategies for new gains in HIV prevention. It describes the state of the HIV epidemic, reviews the national response and makes recommendations for policy and planning. It notes that there are now far fewer infections among teenagers and young adults, but that the significant expansion of anti-retroviral treatment means that the overall prevalence won’t drop for the next five years at least - even if we halve the rate of new infections. For this reason, we now need to use a much sharper measurement of progress than we did in the past.
“In every way, it makes sense to prevent new HIV infection”, says loveLife CEO, Grace Matlhape. “The HIV Prevention Gauge of 2009 shows that progress has been made in combating HIV, but that we still don’t invest enough in a fully-fledged national portfolio of programmes to prevent it. Given the limitations of current knowledge about what really works, we won’t be able to stop all new infections. But we can probably stop half of them. That’s 250,000 new infections averted every year.”

The Prevention Gauge makes the point that there are some obvious and relatively easy places to start.

They include:
• A significant increase in the supply of both male and female condoms, in response to the fact that some of the districts hardest hit by HIV report the lowest distribution of condoms. Furthermore, some of the most severely affected groups, such as offenders in prisons, still have least access to condoms.
• 100% commitment by health workers to ensuring that every HIV-exposed baby receives the full benefit of prevention of mother-to-child transmission. About 30,000 babies are still unnecessarily infected with HIV.
• Greater focus on pregnancy to increase condom use during pregnancy and get pregnant teenagers and new mothers back into school as soon as possible. For every two pregnant teenagers, one has HIV – as a result of the biological and social vulnerabilities associated with pregnancy.
• High-intensity, age-based behaviour change programmes that help protect people through key life transitions like school-leaving. Young people who leave school without employment or further education prospects are at highest risk for HIV.
• The introduction of routine provider-initiated HIV testing in public clinics.

New frontiers for HIV prevention include the introduction of a national programme for male circumcision, and tackling the extraordinarily high tolerance of personal risk in South Africa – despite the knowledge of HIV.

South Africa spends roughly a billion rand of public funds every year on HIV prevention – roughly one-sixth of the total spending on HIV/AIDS programmes. The Gauge estimates that another billion rand is required to implement a national HIV prevention programme at full scale. It points out that, even under conservative projections of impact, net annual savings will be trebled within a decade.

The HIV Prevention Gauge 2009 was funded by the Department for International Development of the United Kingdom.

Additional notes:
The ten top strategies for new gains in HIV prevention:

1. Increase the supply of male and female condoms significantly
2. Eliminate missed opportunities for PMTCT and refocus on protecting the health of pregnant women
3. Scale up focused behaviour change programmes to achieve high levels of inter-personal coverage
4. Focus on reducing risk tolerance
5. Focus on reducing teen pregnancy and protecting pregnant teenagers
6. Introduce routine testing in all public health facilities
7. Institute a high-vigilance protocol for TB detection among people with HIV
8. Introduce a package deal for people presenting with STIs
9. Implement an intensive national quality improvement programme
10. Initiate a male circumcision programme